Therapeutic antibiotic monitoring: surveillance using a computerized expert system.
OBJECTIVE
To develop and evaluate a computerized system to monitor therapeutic antibiotics in a hospital setting.


METHODS
From November 1986 through October 1987, we prospectively monitored 1,632 hospitalized patients who had 2,157 microbiology specimens sent for culture and sensitivity testing. During the study period, computer algorithms were used to identify patients whose antibiotic therapy was inappropriate in relation to microbiology culture and sensitivity data. When inconsistencies occurred between antibiotic therapy and in vitro sensitivity data, computer algorithms generated therapeutic antibiotic monitor (TAM) alerts. A clinical pharmacist then notified the attending physician of the alert.


RESULTS
Antibiotic therapy was identified by the computer as inappropriate in 696 instances (32%). After we eliminated false-positive alerts, 420 evaluable TAM alerts remained. Physicians responded to the TAM alerts by either changing or starting antimicrobial therapy in 125 cases (30%). Moreover, physicians were previously unaware of the relevant susceptibility test results in 49% of the alerts.


CONCLUSIONS
Computer-assisted monitoring is an efficient and promising method to identify and correct errors in antimicrobial prescribing and to assure the appropriate use of therapeutic antibiotics.
Pestotnik
S L
SL
Department of Pharmacy, LDS Hospital, Salt Lake City, Utah 84143.
Evans
R S
RS
Burke
J P
JP
Gardner
R M
RM
Classen
D C
DC
D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D004360:Drug Therapy, Computer-Assisted; D005103:Expert Systems; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D013813:Therapy, Computer-Assisted
D000900:Anti-Bacterial Agents